左旋布比卡因与布比卡因硬膜外阻滞用于产科麻醉的效果.docVIP

0.5%速卡用于产科麻醉的效果及母体和胎儿血药浓度变化的高成杰 宁吉顺 李训美张汝金【摘要】目的 评价0.5%速卡用于硬膜外麻醉剖宫产手术的临床效果，及在母体中血药浓度的变化及经胎盘转运的情况，并以0.5%布比卡因作为对照。方法 选择行择期剖宫产手术足月单胎孕妇43例，硬膜外麻醉时随机分别接受0.5%速卡（L组）或0.5%布比卡因（B组）25ml，观察感觉阻滞（针刺法）、运动阻滞（改良Bromage评分）、镇痛和腹壁肌松质量、ECG变化、新生儿Apgar、NACS评分和脐静脉血气及不良反应。并用高液相色谱法测定母体和胎儿的血浆药物浓度。结果 两组孕妇感觉和运动阻滞的起效时间和持续时间、最高阻滞平面、ECG变化、新生儿Apgar、NACS评分和血气均无统计学差异，低血压的发生率在L组为75.0%，B组为90.0%（P＝0.051），观察中无严重不良反应。L组和B组母体血浆药物浓度在30min左右达高峰，分别为（896±86）ng/ml和（901±79）ng/ml，浓度时间曲线下面积分别为（3167±132）h(ng/ml)和（2935±96）h(ng/ml)，脐静脉/母体静脉血药浓度比（UV/MV）分别为0.300±0.091和0.279±0.116。结论 0.5%速卡适用于产科硬膜外麻醉，麻醉效能与同等浓度和剂量的布比卡因相同，其镇痛和麻醉效果可以满足临床手术需要；对母体副作用少，对新生儿无不良反应；同时药代动力学参数及经胎盘的转运比率两组相似，具有良好的临床应用前景。 【关键词】 速卡；产科麻醉；药代动力学Clinical effects and maternal and fetal plasma concentrations of 0.5% epidural levobupivacaine vs. bupivacaine for cesarean section GAO Cheng-jie, NING Ji-shun LI Xun-mei et al. Department of Anesthesiology, The General Hospital of Jinan Command, Jinan 250031, China 【Abstract】 Objective To study compares the efficacy of 0.5% levobupivacaine with 0.5% bupivacaine in epidural space and study their pharmacokinetics and transfer across placentas. Methods Forty healthy obstetric patients undergoing elective cesarean section with epidural anesthesia completed the study. Patients were randomized to receive 25 ml of either 0.5% levobupivacaine (group L) or 0.5% bupivacaine (group B) in a double-blind fashion. The efficacy endpoint measures included onset, offset, and quality of anesthesia. Neonatal blood gas analyses, Apgar score determinations, and neurobehavioral examinations were performed. Venous samples for pharmacokinetic studies and serial electrocardiograms were obtained in 10 patients in each group. Results Levels of sensory block, motor block, muscle relaxation, and overall quality of anesthesia did not differ between groups. The frequency of hypotension was 75.0% in the levobupivacaine group and 90.0% for the bupivacaine group (P=0.051). No significant difference in observed maximum concentr